What are the challenges for implementing the NHS Long Term Plan?

NHS Non-Executive Directors survey 2019

In January 2019 the NHS Long Term Plan was published. Against increasing pressure on NHS leaders to deal with the day to day, as well as deliver innovation and transformation across their organisations and systems, we believe leadership support and development is critical.

As we head toward the end of this first year of implementation, we asked NHS Non-Executive Directors (NEDs) their views on where they saw the integration of regulation, governance and technology with the Long Term Plan working well and where they thought further work needed to be done. Our review of feedback from NHS Non-Executive Directors, provides leadership insight into these areas from the perspective of those implementing not only the Long Term Plan but also the need to work closer with partners as part of a more integrated system overall.

Our survey shows that whilst the overwhelming majority (73%) of NEDs are confident that their own organisation's plans are aligned to the Long Term Plan, they are less sure when thinking about their organisation's position within the system as a whole, be that regional or national.


We asked if ‘the national regulatory approach positively supports the implementation of the long term plan’. Only 22% of respondents agreed that the national approach supported the implementation of the LTP.

Key areas of concern raised by NEDs included the disjointed approaches to regulation, inconsistency in performance targets for different organisations and there being too many separate legal entities causing issues in the implementation of the LTP and the successful implementation of regulation.

AS NHSE/I embed their new operating model and approach to regulation/performance management and improvement this is something I believe will need to be addressed to give system leaders a real opportunity to drive the transformation and change required to deliver the 10 year plan.

Respondents felt they needed: “...lighter touch regulation to adapt to local needs.”


Governance underpins the core requisite of delivery of the Long Term Plan. However, a majority of respondents were undecided when asked if the governance of the ICS their organisation fits in positively supports the delivery of the Long Term Plan. Only 27% felt that it did, whereas 20% disagreed. A similar view was taken when we asked if governance arrangements for the regional system their organisation sits within, positively supports the Long Term Plan.

We did see a positive response from respondents who felt their own organisation’s governance arrangements had a positive impact on the delivery of the Long Term Plan. We saw 58% agree that it did. This may reflect the visibility of how well governance is operating in their own organisations versus governance at an ICS level which NEDs are often not as well sighted on.

When asked to describe how the key governance challenges faced at an organisation and system level, there was a strong focus on financial accountability, clarity of system governance arrangements and the concept of bringing together a number of complex organisations into a system.

“Creating a common framework would highlight overall strategic objectives and more easily permit robust governance within the overall system.”


The Long Term Plan notes the importance of technology. Asked if technology is being used effectively by their organisation, 39% felt this was not the case, against 36% who did. To break this down, we asked what three changes / implementations to technology were most important in helping deliver the Long Term Plan.

The most important area to respondents is the need to ensure a seamless way to provide shared, joined up services; the most noted elements being joint care records, interconnectivity with other organisations’ systems (including LAs) and shared diagnostic networking.

Some highlighted AI and robotics needing to feature. In comparison, others see the need to get the basics right, with the need to ensure basic infrastructure is sufficient, such as IT systems and the need for mobile and broadband coverage in rural areas. If these basic foundations do not exist, the more complex areas and digital technology cannot be built. This will be critical to ensure technology can be leveraged effectively to deliver the LTP with a reshaped workforce.

“A common data set across the ICS is required to inform and prioritise resource usage aligned to improving population health.”

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David Morris

David Morris

PwC Health Services Sector Leader, PwC United Kingdom

Tel: +44 (0)7841 784180

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